Editorial

The point is, I believe, that many hos-

Customer Satisfaction: pital surveys measure excellence in clin-
ical outcomes but fail to reflect “hospi-
Are Hospitals tality,” the delivery of that care with
grace and a concern for patient well-
being. For example, the Department of
“Hospitable”? Health and Human Services and the
Joint Commission on Accreditation of
Peter D. McCann, MD Healthcare Organizations currently rate
hospitals on appropriate care of patients
with cardiac disease and pneumonia.
e are inundated these days with Curiously, these regulatory agencies

W opinion polls and surveys.

Politicians query the electorate
to determine popular polices;
Nielsen ratings inform us how
many households watch which television programs;
and U.S. News & World Report claims to rank the
“best” colleges, graduate schools, and mutual funds.
measure only one element relevant to
the practice of orthopedic surgery: the
prevention of in-hospital–acquired
infection. These surveys assess treat-
ment but not how that care is delivered;
service, but not “caring.”
Nevertheless, outcome assessment
All of these surveys purport, of course, to reflect the of hospital care is, and will continue to
opinion and preference of the citizen, TV viewer, be, an ever-increasing fact in our pro-
student, or investor. Many are of dubious value, but fessional lives. In fact, Medicare has
all attempt to assess, to a greater or lesser degree, “These surveys recently begun a pilot study linking
customer satisfaction. assess treat- increased hospital reimbursements to
Of course, some customer satisfaction surveys improved clinical outcomes, essentially
are extremely useful. If one wishes to dine in New ment but not a performance-based bonus system for
York, or any other major metropolitan area in the how that care hospitals. While we can complain that
United States, the ubiquitous Zagat Survey guide is these assessments fail to measure true
indispensable. Danny Meyer, one of the most suc- is delivered...” quality of care or assess real “caring,” I
cessful restaurateurs in Manhattan, owns a half a believe that the practicing orthopedic
dozen or so of the 18,000 restaurants in New York surgeon must participate in these exer-
City. The Zagat Survey guide has consistently ranked his restaurants among cises sponsored by regulatory agencies.
the most popular in New York year after year. He attributes his success Given the reality of market influences
over the last 20 years to a commitment to hospitality rather than service in the healthcare arena, hospitals can ill
alone—the perception of the diner that the restaurant staff really cares about afford not to strive to be labeled “best” or
the diner’s total experience, not only that the food is delicious and served “magnet” centers of care. Patients and
without delay. third-party payers place a high value on
Danny’s staff is trained to ensure that the diner feels comfortable, welcomed, such designations. Furthermore, out-
and at home; they are trained to be hospitable: “the reception of guests with lib- come assessments and compliance with
erality and goodwill” (The Compact Oxford English Dictionary, Oxford: Oxford ‘best practice” standards are, indeed,
University Press, 1971). In fact, the modern definition of hospital is derived essential and important measures of
from its medieval origin (sounding very much like today’s restaurant): “a place quality of care. However, in the assess-
for the shelter and care of pilgrims and guests” (The Compact Oxford English ment of overall quality, such surveys are
Dictionary). As practitioners in the field of medicine, we have, I believe, much necessary but not sufficient.
to learn from the restaurant field; both are service industries. In the current climate in which sur-
Dr. William A. Grana, a department editor of this journal, has written elo- veys of all sorts are the rage, we would
quently in these pages recently of the hospital experience of his ailing moth- do well to remember the ancient origin
er. He describes her care in a “magnet hospital,” cited for excellence by the of “hospital” and appreciate the “mis-
American Nursing Association, as competent but not “caring”—that is to sion” that the hospital and restaurant
say, serviceable but without being hospitable. He concluded that hospitals industries currently share: service in a
have lost their way, focusing more on excellent survey scores than on com- caring environment. Hospitals must
passionate care of patients. This may be true. also be hospitable. ■

February 2006 59